Serial # 2205 order # A 102
Charles Fenton JACKSON
Perm. Home Address - Unison Loudoun Va
age - 38
d.o.b. - Feb 7 1880
Negro
Present Occupation - None most of time
Employer's Name - Has no employer
Place of Employment - Lives near Unison Loudoun VA
Nearest relative - Julia Jackson
Unison Loudoun VA
X (his mark)